Provider Demographics
NPI:1114239845
Name:NEW IMAGE LIFE COACHES & ASSOCIATES
Entity Type:Organization
Organization Name:NEW IMAGE LIFE COACHES & ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLIENT COACH/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REGINALD
Authorized Official - Middle Name:A
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-362-6256
Mailing Address - Street 1:4334 SNOW MASS LANE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38141
Mailing Address - Country:US
Mailing Address - Phone:901-362-6256
Mailing Address - Fax:
Practice Address - Street 1:4334 SNOW MASS LANE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38141
Practice Address - Country:US
Practice Address - Phone:901-362-6256
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-10
Last Update Date:2010-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174H00000XOther Service ProvidersHealth EducatorGroup - Single Specialty